在联合抗逆转录病毒治疗时代，当前 CD4 计数≥200 个/μL 时艾滋病定义性疾病的发病率。
The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era.
机构信息
Department of Infection and Population Health, University College London, United Kingdom.
出版信息
Clin Infect Dis. 2013 Oct;57(7):1038-47. doi: 10.1093/cid/cit423. Epub 2013 Aug 6.
BACKGROUND
Few studies consider the incidence of individual AIDS-defining illnesses (ADIs) at higher CD4 counts, relevant on a population level for monitoring and resource allocation.
METHODS
Individuals from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) aged ≥14 years with ≥1 CD4 count of ≥200 µL between 1998 and 2010 were included. Incidence rates (per 1000 person-years of follow-up [PYFU]) were calculated for each ADI within different CD4 strata; Poisson regression, using generalized estimating equations and robust standard errors, was used to model rates of ADIs with current CD4 ≥500/µL.
RESULTS
A total of 12 135 ADIs occurred at a CD4 count of ≥200 cells/µL among 207 539 persons with 1 154 803 PYFU. Incidence rates declined from 20.5 per 1000 PYFU (95% confidence interval [CI], 20.0-21.1 per 1000 PYFU) with current CD4 200-349 cells/µL to 4.1 per 1000 PYFU (95% CI, 3.6-4.6 per 1000 PYFU) with current CD4 ≥ 1000 cells/µL. Persons with a current CD4 of 500-749 cells/µL had a significantly higher rate of ADIs (adjusted incidence rate ratio [aIRR], 1.20; 95% CI, 1.10-1.32), whereas those with a current CD4 of ≥1000 cells/µL had a similar rate (aIRR, 0.92; 95% CI, .79-1.07), compared to a current CD4 of 750-999 cells/µL. Results were consistent in persons with high or low viral load. Findings were stronger for malignant ADIs (aIRR, 1.52; 95% CI, 1.25-1.86) than for nonmalignant ADIs (aIRR, 1.12; 95% CI, 1.01-1.25), comparing persons with a current CD4 of 500-749 cells/µL to 750-999 cells/µL.
DISCUSSION
The incidence of ADIs was higher in individuals with a current CD4 count of 500-749 cells/µL compared to those with a CD4 count of 750-999 cells/µL, but did not decrease further at higher CD4 counts. Results were similar in patients virologically suppressed on combination antiretroviral therapy, suggesting that immune reconstitution is not complete until the CD4 increases to >750 cells/µL.
背景
很少有研究关注在较高 CD4 计数时个体 AIDS 定义疾病（ADIs）的发病率，这在监测和资源分配方面具有人群层面的重要性。
方法
我们纳入了 Collaboration of Observational HIV Epidemiological Research Europe（COHERE）中年龄≥14 岁、1998 年至 2010 年间至少有一次 CD4 计数≥200 µL 的≥1 次的个体。在不同 CD4 分层中，计算每一种 ADI 的发病率（每 1000 人年随访[PYFU]的发病率）；使用广义估计方程和稳健标准误差的泊松回归来对当前 CD4≥500/µL 的 ADI 进行发病率建模。
结果
在 207539 名具有 1154803PYFU 的个体中，在 CD4 计数≥200 个细胞/µL 时共发生了 12135 例 ADI。发病率从当前 CD4 为 200-349 个细胞/µL 时的每 1000PYFU 20.5 例（95%置信区间[CI]，每 1000PYFU 20.0-21.1 例）下降至当前 CD4≥1000 个细胞/µL 时的每 1000PYFU 4.1 例（95%CI，每 1000PYFU 3.6-4.6 例）。当前 CD4 为 500-749 个细胞/µL 的个体 ADI 发生率显著更高（校正发病率比[aIRR]，1.20；95%CI，1.10-1.32），而当前 CD4 为≥1000 个细胞/µL 的个体 ADI 发生率相似（aIRR，0.92；95%CI，0.79-1.07），与当前 CD4 为 750-999 个细胞/µL 的个体相比。在高病毒载量或低病毒载量个体中结果一致。恶性 ADI 的发生率高于非恶性 ADI（aIRR，1.52；95%CI，1.25-1.86），而与当前 CD4 为 500-749 个细胞/µL 的个体相比，当前 CD4 为 750-999 个细胞/µL 的个体（aIRR，1.12；95%CI，1.01-1.25）。
讨论
与当前 CD4 计数为 750-999 个细胞/µL 的个体相比，当前 CD4 计数为 500-749 个细胞/µL 的个体的 ADI 发病率更高，但在更高的 CD4 计数时不会进一步下降。在接受联合抗逆转录病毒治疗病毒学抑制的患者中结果相似，表明 CD4 增加到>750 个细胞/µL 之前免疫重建尚未完全完成。
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